Walking again is not my “gold standard.” If I could take a pill and be cured of paralysis and be able to walk, that is just fine. But I guarantee you that in this chair I could keep up with any one of you going down the street outside. My problem everyday is the little things. It is the pressure sore. It is the dexterity. It is that kind of thing that I wish that we could make progress as far as restoration of function is concerned.

—John Bollinger

Paralyzed Veterans of America

FROM CHALLENGES TO OPPORTUNITIES

Although breakthroughs in the biomedical sciences in the past 50 years have resulted in medications and interventions for the treatment of many health disorders and diseases, progress in treating spinal cord injuries has been slow and uneven. However, a confluence of factors (described below) now points to more rapid progress. Some of the hurdles that have stymied progress in the past are now being overcome and other opportunities are being realized. A few of these opportunities are highlighted below, and these and others are further discussed throughout the report.

  • Understanding the biology of the nervous system. For years it was thought that neurons in mammals do not regenerate and that it was not possible to initiate axonal growth. However, beginning in the 1980s, the discovery that neurons in rat spinal cords could regenerate and make functional connections and that regeneration could be enhanced with changes in the environment of the damaged nerve cells opened possibilities to an array of research approaches to the treatment of spinal cord injuries. Other recent advances—including the ongoing elucidation of the biological blockers and promoters of nerve regeneration—have continued to accelerate research progress and move research closer toward clinical therapies

  • Emergency medical treatment. Emergency care for individuals with spinal cord injuries has only recently reached a point at which rapid response, standardized protocols for the immobilization and treatment of neck injuries, and the training of emergency medical technicians have led to increased survival rates and decreases in the number of complete spinal cord injuries. More patients thus present to the emergency department with residual function. Furthermore, the challenges of conducting clinical trials of emergency care interventions may be beginning to be overcome with the development of networks of trauma centers and the development of protocols and standards for addressing informed-consent issues in emergency situations.

  • Research tools and imaging techniques. Improved laboratory tech-



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